What Failing the At-Home Dementia Test Means for Your Brain

While flipping through TikTok last week, one video caught my eye. “The quickest test for dementia,” read the caption on a clip of a neurologist, @adnanmd, making a series of hand gestures.

Reminiscent of rock-paper-scissors, the test asks you to quickly transition through three separate hand movements—fist, edge, palm—and repeat the sequence. According to the video, which has been viewed 8.2 million times, the sequence helps tap into different functions of your brain. The vast majority of people with healthy cognition ace it, while those who have Alzheimer’s or frontotemporal dementia are likely to struggle.

Who doesn’t want some easy validation that their brain is doing great? I decided to try it myself.

Fist, edge, palm.

Great, easy. Now for the second time around.

Fist, edge…not palm.

Oh no.

On that second attempt, my brain short-circuited, turning my third motion into a weird edge-palm hybrid. I tried it again. Same thing: First time, smooth sailing. Second cycle, disaster.

Slightly curious and more than a little unsettled, I headed to the comment section—and found many more people flubbing it like I did. “I started doing rock paper scissors at one point,” one commenter wrote. “Hey so I learned something alarming about myself today,” said another.

And then: “Why are all the comments saying they can’t do it, are you guys okay genuinely?”

To be fair, I couldn’t stop wondering about my own cognitive health, either. So I decided to ask a neuropsychologist for the answer.

Meet the expert: Aimee Karstens, Ph.D., a clinical neuropsychologist and assistant professor in the department of neurological sciences at Rush University.

What is this dementia test, and how legit is it, really?

It’s called the Luria test, and it has decades of clinical backing. Russian neuropsychologist Alexander Luria developed it to test brain function in soldiers who experienced traumatic brain injuries during World War II, explains clinical neuropsychologist Aimee Karstens, Ph.D., an assistant professor in the department of neurological sciences at Rush University. “He really started doing these very qualitative assessments that ended up becoming the basis for a lot of what we use today,” she says. “So there is a large history there.”

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Some versions of the Luria test use different phrasing and sequences, but the goal is always the same: to seamlessly transition through three separate hand movements. First, fingers curled into palm (“fist,” in the video); then a chopping or cutting motion (“edge”); and finally, palm down and fingers extended (“palm”).

“The idea of having this three-step sequence is that it taps into a few different brain functions,” says Karstens. “There’s executive functioning because it requires you to do a planned motor sequence. It requires a certain level of working memory because you have to hold onto the three things you are supposed to do.” And motor function, or your nervous system’s ability to coordinate with your muscles to trigger certain movements, also plays a role.

“There’s also a part of it that’s designed to be a little awkward,” she says. “When you do it, it’s like you want to do it in a different way because of what motorically feels more natural. So it taps into a bit of inhibition, too.”

When done in a clinical setting, the Luria test has been found to reliably distinguish between cognitively healthy folks and those with impairment. According to a 2011 study of 383 patients in a university dementia clinic, abnormal results occurred in only 2% of cognitively healthy people, but in 21% of those with mild cognitive impairment, 60% of those with Alzheimer’s disease, and 70% of those with frontotemporal dementia.

So what does flubbing it mean for my brain?

That context is crucial: When done in a clinical setting is an important part of the equation that can’t be overstated. “It’s designed very specifically to be done in a clinical setting, not [by] someone sitting at home who’s watched a video,” says Karstens.

There are some big differences there that can affect your performance in it. “When you’re with the clinician, they’re demonstrating it to the patient, and the patient has a chance to learn it. That’s different than you watching a really fast TikTok video and saying, ‘Oh, can I do that?’” she says. “In a person with normal cognition, it’s not uncommon during that learning phase for them to make a mistake.”

It’s almost like learning a dance move, she says. It’s tricky for lots of people to mimic after a one-and-done video.

And that’s something I certainly struggle with, too—I can’t follow a dance video to save my life. My awkwardness and self-consciousness about doing something wrong make me overthink each move, which makes the whole situation even worse. This probably played a big role in my initial struggles with the Luria test. Following my first two flubs, I slowed down and learned the sequence step by step. After that, I was able to do it smoothly, without errors.

It’s after this initial learning phase that flubs can be a little more telling—as can being unable to grasp the motions even after solid demonstration, says Karstens. Getting repeatedly caught up in the same spot can raise suspicions of cognitive issues, too.

But even then, it’s just not a one-and-done test: It’s used in conjunction with other clinical tests and assessments to get a more thorough understanding of the patient. And because it’s a qualitative test, clinicians can interpret the results with some nuance.

What’s the takeaway here?

On its own, flubbing the test isn’t a red flag, Karstens says. The test only provides a snapshot of your cognitive performance—and not a particularly strong one, either, if mimicked off a video without a clinician’s oversight.

Of course, if in addition to failing the test at home, you have other cognitive concerns—or if you’ve had a head injury with loss of consciousness or a family history of dementia—it might be something worth bringing up with your provider.

“It all comes with the full context,” she says. “If someone makes an error on this simple test, but everything else that I’m seeing in my evaluation is normal, I’m not really concerned.”